Screening programs represent the best tool to prevent CRC. Colonoscopy (C) is an effective CRC screening test, allowing entire colon examination, and adenomas removal, but a Cscreening program is difficult and expensive to perform in the general population. Since recent data have shown that first degree relatives of CRC patients are at increased risk for adenoma, we designed a screening program focused on this population. On October 1999 we starded a campaign stressing the usefulness of C in first degree relatives of CRC patients (meetings with GPs and surgeons, public conferences, a dedicated web site, printed booklets, newspaper articles, local radio/-rv program). Moreover, all patients undergoing surgery for CRC were asked to inform their first degree relatives about the program. All subjects aged between 45-75 yr with at least one first-degree relative with CRC were invited to a preliminary interview, in order to collect personal and family data and to suggest C as screening option. When C was refused, barium enema or faecal occult blood test were suggested. From January 2000 to October 2001, 359 subjects were interviewed (174 ma/es and 185 females, mean age 56.7): 279 had one parent, 77 one brother and 3 one son affected by CRC. 5 subjects refused to participate in the study, 22 refused C (13 chose barium enema, and 9 faecal occult blood test: all these subjects had negative findings). 332 agreed to C (92.5%): 276 C have been already performed (56 are scheduled). Polyps were found in 86 subjects (31.1%): 25 hyperplastic polyps and 61 adenomas (22.1% of C performed). Among adenomas, 43 (70.5%) were tubular, 12 (19.7%) tubulovillous, and 6 (9.8%) villous with severe dysplasia. Moreover, one carcinoma (Dukes A) was found. Multiple adenomas were found in 27 (44.2%), and in 24 (39.3%) the diameter was >1 cm. No complications related to C or polypectomy were observed. Total direct cost for C-based screening was $77,400. Costs were largely due to C (64%): mean single C cost $125, total C cost $41,430 (including histology). Indirect costs, particularly volunteer service needful for the campaign, were not included. Conclusions: - Compliance is fundamental for screening programs effectiveness: a 92.5% compliance was reached -Our results confirm a high prevalence of adenomas and early colon cancer in first degree relatives of CRC patients -Our preliminary data of cost analysis suggest the effectiveness of C in increased risk patients. A C-based screening in selected high risk populations is probably cost-effective
Cost-effectiveness of colonoscopy colorectal cancer (CRC) screening in asymptomatic increased risk subjects
LANZA, Giovanni;
2002
Abstract
Screening programs represent the best tool to prevent CRC. Colonoscopy (C) is an effective CRC screening test, allowing entire colon examination, and adenomas removal, but a Cscreening program is difficult and expensive to perform in the general population. Since recent data have shown that first degree relatives of CRC patients are at increased risk for adenoma, we designed a screening program focused on this population. On October 1999 we starded a campaign stressing the usefulness of C in first degree relatives of CRC patients (meetings with GPs and surgeons, public conferences, a dedicated web site, printed booklets, newspaper articles, local radio/-rv program). Moreover, all patients undergoing surgery for CRC were asked to inform their first degree relatives about the program. All subjects aged between 45-75 yr with at least one first-degree relative with CRC were invited to a preliminary interview, in order to collect personal and family data and to suggest C as screening option. When C was refused, barium enema or faecal occult blood test were suggested. From January 2000 to October 2001, 359 subjects were interviewed (174 ma/es and 185 females, mean age 56.7): 279 had one parent, 77 one brother and 3 one son affected by CRC. 5 subjects refused to participate in the study, 22 refused C (13 chose barium enema, and 9 faecal occult blood test: all these subjects had negative findings). 332 agreed to C (92.5%): 276 C have been already performed (56 are scheduled). Polyps were found in 86 subjects (31.1%): 25 hyperplastic polyps and 61 adenomas (22.1% of C performed). Among adenomas, 43 (70.5%) were tubular, 12 (19.7%) tubulovillous, and 6 (9.8%) villous with severe dysplasia. Moreover, one carcinoma (Dukes A) was found. Multiple adenomas were found in 27 (44.2%), and in 24 (39.3%) the diameter was >1 cm. No complications related to C or polypectomy were observed. Total direct cost for C-based screening was $77,400. Costs were largely due to C (64%): mean single C cost $125, total C cost $41,430 (including histology). Indirect costs, particularly volunteer service needful for the campaign, were not included. Conclusions: - Compliance is fundamental for screening programs effectiveness: a 92.5% compliance was reached -Our results confirm a high prevalence of adenomas and early colon cancer in first degree relatives of CRC patients -Our preliminary data of cost analysis suggest the effectiveness of C in increased risk patients. A C-based screening in selected high risk populations is probably cost-effectiveI documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
